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sustained hypertension had a greater risk of renal events. This gradient of risk across
ABPM-based phenotypes suggest a need to have greater use of ABPM in order to
better utilize resources, improve clinical outcomes, and avoid harms in hypertensive
CKD populations. Future studies are needed to determine whether treatment deci-
sions based on accurate phenotyping of hypertension in CKD improves outcomes.
A recent study reported clinical outcomes of aTRH in 3367 hypertensive partici-
pants with non-dialysis CKD from the Chronic Renal Insufficiency Cohort (CRIC)
[ 11 ]. Pseudoresistance was partly excluded by assessing medication adherence but
only office BP was available. Compared to those without aTRH, those with aTRH
were older (61 vs 58 years) with more prevalent evidence of end-organ damage.
Age, male sex, black race, presence of diabetes, and greater body mass index were
independently associated with the presence of aTRH. Doubling of proteinuria was
associated with 28% greater odds of aTRH, and each 5 mL/min/1.73 m^2 decline in
eGFR was associated with 14% greater odds of aTRH. In unadjusted survival analy-
ses aTRH was associated with increased cardiovascular and renal events (Fig. 5.3).
In multivariable-adjusted survival analysis, aTRH had hazard ratios of 1.5 (95% CI,
1.3–1.7) for cardiovascular outcomes, 1.3 (95% CI, 1.1–1.5) for renal events, and
1.2 (95% CI, 1.1–1.5) for all-cause mortality. While ABPM is clearly preferred to
phenotype hypertensive CKD populations, this study emphasizes that even an office
BP diagnosis of aTRH identifies a high-risk group.
A recent report from the REasons for Geographic And Racial Difference in
Stroke (REGARDS) observational cohort compared cardiovascular outcomes in
2043 participants with aTRH to 12,479 without TRH [ 18 ]. Diagnosis of aTRH used
00.0
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0.2
0.3
0.4
0.5
0.6
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1.0
ab12CV event-free survival Renal event-free survival3
Follow up (years) Follow up (years)Log-rank 17.0, P=0.0007456789 00.00.10.20.30.40.50.60.70.80.91.0123Log-rank 41.6, P<0.0001456789Fig. 5.2 Cardiovascular and renal survival by hypertensive status phenotyped by ambulatory
blood pressure monitoring in 436 patients. Control subjects are in green, pseudoresistance in blue,
sustained hypertension in orange, and true resistance in red (Reproduced with permission from
study with Ref. [ 17 ])
A. Odudu et al.